Documenti di Didattica
Documenti di Professioni
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roots
international magazine of
Vol. 9
Issue 3/2013
endodontology
2013
| CE article
Endodontic retreatment
and adhesive restoration of
structurally compromised
second premolar
| research
| case report
Eight-year follow-up of successful
intentional replantation
www.vdw-dental.com
one le endo
editorial _ roots
Dear friends
and colleagues,
_It is with great honour and pleasure that I write the editorial for this years third issue of the
roots magazine. Throughout my career, I have always believed in the importance of collaboration
Dr Hakki Sunay
between dental practitioners and specialists, and it is undeniable that dental journals offer an indispensable means of fostering interaction and communication between dental professionals. I also
strongly feel that endodontic specialists should be continuously involved in collaborative activities,
and the delivery of up-to-date information by means of journals is a very efficient means of sharing
ones experience and knowledge. Endodontic specialists, and all other dental practitioners, should also
be encouraged to participate in symposiums and conferences pertaining to the field and subscription
to a specialty journal can be a very efficient means of creating and maintaining a scientifically based
professional foundation.
It is amazing how rapidly the specialty of endodontics has developed and evolved, especially in the
last decade, with new approaches and methodologies regularly being unveiled, as well as paradigm
shifts that might alter our conventional methodologies through the introduction of innovative and
productive devices. Instrumentation has always been a challenge for endodontists and we are living in
an era in which rapid delivery of quality dental service is expected. New methodologies and instrumentation systems are continuously being launched to facilitate endodontic patients comfort and
to ease the practitioners work. This issue of the magazine contains the most recent information
concerning new shaping strategies; readers are introduced to new options and encouraged to make
comparisons with their routine methodologies.
Imaging and magnification are considered very important steps in state-of-the-art endodontic
care, and it is indisputable that one is enabled to perform sensitive procedures in endodontic treatment
when good visualisation is rendered possible. You will find in this issue information on visual data and
imaging that will enhance the quality of your endodontic treatments. Case reports are a good means
of sharing ones experience with others, and through commentary on and analysis of unique cases
dental practitioners can be provided with sufficient information on cases they might encounter in their
practices. In this issue, in the belief that such information is very helpful for enhancing the vision of
a dental practitioner, interesting cases with efficient treatment modalities and sufficient follow-up
periods are presented.
Finally, the European Society of Endodontology congress is soon to be held in Lisbon in Portugal,
and we are expecting to enjoy a lively scientific programme with mutual discussions, the exchange
of ideas and the enhancement of existing knowledge. I wish all participants a pleasant and productive
congress, and I hope that the upcoming event will serve as a successful means of supporting our
endeavours in striving to offer the best service in our patients best interest.
My best wishes to all readers and colleagues,
Dr Hakki Sunay
Associate Professor, Faculty of Dentistry, Yeditepe University
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content _ roots
page 6
28
I editorial
03
page 16
page 24
I opinion
I CE article
06
32
I industry news
34
I research
12
34
36
I industry report
16
38
I meetings
I technique
22
40
I case report
24
International Events
|
|
submission guidelines
imprint
page 28
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page 34
page 40
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I CE article _ retreatment
Endodontic retreatment
and adhesive restoration of
structurally compromised
second premolar
Authors_ Drs Stela Nicheva, Lyubomir St. Vangelov & Ivan Filipov, Bulgaria
roots
_ce credit
By reading this article and then taking a short online quiz, you can gain
ADA CERP CE credits. To take the
CE quiz, visit www.dtstudyclub.com
The quiz is free for subscribers,
who will be sent an access code. Please write
support@dtstudyclub.com if you dont receive it.
Non subscribers may take the quiz for a $20 fee.
Fig. 1
Fig. 2
06 I roots
3_ 2013
Fig. 3
CE article _ retreatment
Fig. 4
Fig. 5
Fig. 6
_Case report
A 34-year-old male patient reported to the department of Operative Dentistry and Endodontics,
complaining of symptoms from another tooth. The
radiographic examination (Fig. 1) revealed inadequate endodontic treatment and perforation with
radiolucent area at the apex of tooth 15. The tooth
was endodontically treated four years ago.
Fig. 7
Fig. 8
Fig. 9
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I CE article _ retreatment
Fig. 10
Fig. 11
3_ 2013
After the completion of the endodontic retreatment, the pre-endodontic buildup was left at place and
the endodontic access was restored again with SDR,
creating a core, on which an onlay preparation with
diamond burs (Mani Inc.) was performed (Figs. 8 & 9).
The enamel margins were exposed and unsupported
enamel prisms were removed using fine-grit diamond
points. The remaining tooth structure was prepared to
create a butt-joint with the restoration margins. Internal line angles were rounded and the walls provided
5- to 15-degree path of divergence. The proximal boxes
08 I roots
CE article _ retreatment
Fig. 13
_Discussion
This case report demonstrates endodontic retreatment and composite onlay as definitive restoration for a compromised tooth with minimal coronal
tooth structure.
The two most important factors in terms of prognosis of treatment of perforations are the age of
the lesion and degree of bacterial contamination.13
In our case, the previous endodontic treatment was
done four years ago. The long period of time is not
favourable for the prognosis, but since the perforation is in the apical third the likelihood of bacterial
contamination is low. After the patient has been informed, he chooses orthograde endodontic retreatment as a treatment modality.
The material of choice for perforation repair is
MTA (mineral trioxide aggregate). Because of the
small size and apical position of the lesion, we decided to treat it like a second canal and to obturate
with gutta-percha and MTA based sealer. The absence of worsening of the periapical conditions in
the six months post-op X-ray (Fig. 19) supports this
approach, and the patient is still under observation.
Although still debatable, recent comprehensive
meta-analysis by Gillen et al.6 demonstrates that a
Fig. 14
Fig. 15
An endodontically treated posterior tooth presenting with extensive decay is most frequently restored with a post and a crown. That is intelligible,
because crowns are a well-established and known,
clinically proven restorative modality, and still a
considerable amount of research is being performed
in this direction.15 On the other hand, partial toothcoloured restorations are recognized as valuable
alternatives to full coverage crowns, and questions
are raised if intracanal posts are necessary at all for
an endodontically treated tooth.
Since their introduction in 1980,16 indirect laboratory processed composites are being continuously improved in their physical and mechanical
properties. Now this restorative option offers ad-
Fig. 16
Fig. 17
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I CE article _ retreatment
Fig. 18
Fig. 19
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roots
Youre in control > TF Adaptive is designed to work with our ElementsTM Adaptive Motion
Technology, which allows the TF Adaptive le to self-adjust to intra-canal torsional forces.
In other words rotary when you want it and reciprocation when you need it.
Keep it simple > An intuitive, color-coded system designed for efciency and ease of use.
Peace of mind > TF Adaptive is built on the success of the Classic TF design and includes
the same advanced Twisted File technology.
Radiograph courtesy of Dr. Gary Glassman.
Trusted by
Gary Glassman, D.D.S.
Endodontist
Toronto, Canada
tfadaptive.com
I research _ instrumentation
_Introduction
The introduction of the nickel-titanium (NiTi) alloy in endodontics was a significant improvement,
allowing good results in terms of cleaning and shaping of root canals, while reducing operative time and
minimising iatrogenic errors.1,2 Owing to the superior mechanical properties of the NiTi alloy, it was
possible to use endodontic instruments of greater
tapers in continuous rotation to increase the effectiveness and rapidity of the cutting.3 However,
several studies reported a significant risk of intracanal separation of NiTi rotary instruments.47
Although multiple factors contribute to file separation, cyclic fatigue has been proven to be one of the
leading causes.8 Fatigue failure usually begins with
the formation of microcrack at the surface of the file
that arises from surface irregularities. During each
loading cycle, microcracks develop, deepening until
complete separation of the file occurs.9 All endodontic files show some irregularities on the surface
and inner defects as a consequence of the manufacturing process, and the distribution of these defects influences fracture strength of the endodontic instruments.10,11
NiTi instruments have traditionally been used
with a continuous motion, but in recent years a new
approach to the use of NiTi instruments in a reciprocating motion has been introduced.12 In Yareds
study,12 only one F2 ProTaper NiTi rotary instrument
Dentsply (York, PA) was used for canal preparation
in a clockwise (CW) and counter-clockwise (CCW)
movement. The CW and the CCW rotations used by
Yared were four-tenths and two-tenths of a circle,
respectively, and the rotational speed was 400rpm.12
The concept of using a single NiTi instrument to pre-
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pare the entire root canal is interesting, and it is possible because reciprocating motion is thought to reduce instrumentation stress, and new instruments
have recently been introduced based on these concepts (e.g. WaveOne, DENTSPLY Tulsa Dental Specialties). Literature data has demonstrated that reciprocating motion can extend cyclic fatigue resistance of NiTi instruments compared with continuous
rotation.1315 Moreover these positive results have
been an initial step for further studies because many
different reciprocating movements and many different instrument designs can be used in clinical
practice, thus affecting the overall results.
More recently, a new instrumentation technique
(TF Adaptive) has been developed by Axis|SybronEndo, aimed at combining the advantages of both
continuous rotation and reciprocation. More precisely TF Adaptive uses Adaptive Motion, a patented,
undisclosed motion provided by a new endodontic
motor, the Elements Motor (Axis|SybronEndo, Coppell, TX) that automatically adapts to instrumentation stress (Fig. 1). When the TF Adaptive instrument
is not (or very lightly) stressed, the movement can
be described as an interrupted continuous rotation,
allowing optimal cutting efficiency and removal of
debris, since cross-sectional and flute designs are
meant to perform at their best in a CW motion. On
the contrary, while negotiating the canal, owing to
increased instrumentation stress and metal fatigue,
the motion of the TF Adaptive instrument changes
into reciprocation with specifically designed CW
and CCW angles. Moreover, these angles are not
constant, but vary depending on the anatomical
complexities and the intra-canal stress. This adaptive motion is therefore meant to reduce the risk of
intra-canal failure without affecting performance,
research _ instrumentation
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I research _ instrumentation
Fig. 2_The TF Adaptive workflow.
were rotated or reciprocated until fracture occurred. The time to fracture was recorded visually
with a 1/100-second chronometer. Mean and standard deviations were calculated. All data was
recorded and subjected to statistical evaluation
with an analysis of variance test. (Statistical significance was set at P < 0.05.)
The other 20 instruments were randomly assigned to Group 3 (Adaptive Motion) and Group 4
(continuous rotation), and they were used to prepare a curved artificial canal in a transparent plastic
block (SybronEndo preparation block) using a single-file instrumentation technique. Instrumentation time to reach working length was recorded visually with a 1/100-second chronometer. Mean and
standard deviations were calculated. All data was
recorded and subjected to statistical evaluation
with an analysis of variance test. (Statistical significance was set at P < 0.05.)
Fig. 3_Cyclic fatigue resistance of TF
#25.06 used with Adaptive Motion
(AD: yellow column) and continuous
rotation (CR: red column).
Fig. 4_Cyclic fatigue resistance of TF
#25.06 used with Adaptive Motion
(AD: yellow column) and continuous
rotation (CR: red column).
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_Results
Adaptive Motion showed a significant increase
(p<0.05) in the time to fracture compared with continuous rotation. The mean time to fracture was 239
seconds (SD 11.5 seconds) for Group 1 and 116 seconds (SD 9.5 seconds) for Group 2. The mean instrumentation time was 11.5 seconds (SD 1.5 seconds) for
Group 3 and 11.2 seconds (SD 1.5 seconds) for Group
4. Statistical analysis did not find significant differences (p >0.05) between the two groups.
_Discussion
Although multiple factors contribute to file separation, cyclic fatigue has been demonstrated to be one
of the leading causes.17 Recently, the advancement in
TF technology and the manufacturing process has allowed the production of a new generation of NiTi instruments, with better flexibility and greater resist-
research _ instrumentation
study significantly. On the contrary, these changes influenced resistance to metal fatigue, since TF instruments used with Adaptive Motion were found to have
superior resistance to cyclic fatigue compared with
the same TF instruments used in continuous rotation.
Hence, we may conclude that Adaptive Motion has a
positive effect on safety (measured by in vitro resistance to cyclic fatigue), while maintaining efficiency
(cutting ability measured by in vitro instrumentation
time) of TF instruments compared with traditional
continuous rotation._
Editorial note: A complete list of references is available
from the publisher.
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I 15
MounceFiles: A safe,
economical and efficient
option for canal preparation
Author_ Dr Rich Mounce, USA
ods of shaping root canal systems, i.e., the MounceFile. This article was written both to introduce the
MounceFile and suggest that the reader compare his
or her present systems and treatment strategies for
achieving the goals of canal preparation.
The goals of canal preparation are to:
_Maintain the original position of the canal.
_Maintain the original position and size of the apical
foramen.
_Prepare a tapering funnel with narrowing crosssectional diameters (in essence, to mimic the shape
of a tornado).
_Prepare a taper that is proportional to the external
dimensions of the root that does not predispose the
root to subsequent vertical root fracture.
_Prepare a taper that allows cone fit with tug back and
ideal obturation hydraulics during down pack with
warm vertical obturation techniques (and warm
techniques of all types).
_Prepare a taper that optimizes the necessary volume
and space for activation of endodontic irrigants.
Fig. 1a
Figs. 1a & b_The MounceFile SNT
Assorted Pack.
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Among other valid and clinically proven marketplace choices, MounceFiles represent a literaturebased, clinically valid, safe, efficient and economical
option for canal preparation.
Fig. 1a
Fig. 2a
_Universal application
It is a personal bias that not every instrumentation
system is applicable to all canal anatomy encountered. Canal anatomy is infinite in its diversity (threerooted lower molars, etc.), variety (length, curvature,
etc.), clinical challenge (resorption, immature apices,
etc.) and the environment in which these canals are
treated (limited opening, excessive swallowing by
patients, etc.). One size fits all algorithms work some
or most of the time, but given the above variables, in
the wrong clinical situation, otherwise typical clinical
actions can lead to iatrogenic events.
MounceFiles come in two forms of nickel titanium,
Controlled Memory (CM) and standard nickel titanium (SNT). CM nickel-titanium files result from a
proprietary thermomechanical treatment of nickeltitanium whereby once curved, the files remain
curved. Clinically, this means that as a CM instrument
rotates through a curvature, the file remains curved,
a valuable attribute in a complex canal. SNT files are
superelastic, meaning they spring back to their original shape after being stressed (used clinically). CM instruments have shown increased resistance to cyclic
fatigue and other attributes relative to their superelastic counterparts.15
Fig. 2d
MounceFiles are square in cross section, nonlanded and of constant taper throughout their
cutting flutes. The square cross-section provides
added fracture resistance relative to triangular
cross sections due to the increased metal mass
in this dimension.
The MounceFile Assorted Pack is designed
more for the general dentist and the typical
endodontic case. Specifically, this pack is
ideal for teeth that are 1823mm long, have
roots of moderate curvature and canals that
are located with relative ease and negotiable with hand files. The MounceFile CM
Assorted Pack and MounceFile SNT Assorted
Pack are configured (from left to right in
the box) from larger tapers to smaller:
.08/25; .06/25; .04/25; .03/25; .02/25, .03/30
(Fig. 1).
Fig. 2b
The MounceFile system was developed to give endodontists a virtually unlimited choice of tapers and
tip sizes to custom assemble their file configurations
and handle virtually any clinical case. If the endodontist (or general dentist handling complex cases) wants
to customize his or herselection of MounceFiles, there
are 75 combinations of taper and tip size available in
both CM and SNT files. Tapers include .01 in addition
to the tapers present in the assorted packs. Tip sizes
among the tapers range from 2060, depending on
the taper.
Fig. 2c
_Clinical technique
The following directions for use and FAQs have been
adapted from PDFs on the www.MounceEndo.com
website. These directions reference the MounceFile
CM Assorted Pack. The directions for the
MounceFile SNT Assorted Pack are identical to those below.
Specifically, the MounceFile CM Assorted
Pack is used within the context of the following
treatment steps:
Step 1: Estimate the true working length
Before making access, the clinician should estimate the true working length (TWL) from the initial
preoperative radiographs. This is the estimated working length (EWL). The EWL is used later to help confirm the TWL, which is determined radiographically
or electronically (Foramatron-Parkell, Elements Diagnostic Unit-Axis/Sybron, Root ZX II-J Morita).
Step 2: Prepare straight-line access
Straight-line access is achieved when all of the
canals can be seen in one mirror view and hand
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Fig. 3b
No set of instructions or precautions is comprehensive. Evaluation of clinical risks is essential. Treatment algorithms and clinical strategies must often be
revised in the face of anatomical challenges (severe
calcification, curvature, open apices, etc.). Clinical
judgment and caution are advised.
_FAQs
_What is Controlled Memory (CM) and how do these
files differ from standard nickel-titanium files?
Controlled Memory instruments have been subjected to a proprietary thermomechanical treatment
that provides significant resistance to cyclic fatigue
relative to nickel-titanium (NT) instruments without
this treatment. When a CM instrument curves during
AD
Biological &
Conservative
FKG Dentaire SA
www.fkg.ch
Fig. 4a
Fig. 4b
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Fig. 5a
Fig. 5b
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_The frontiers in dental technology are constantly in a state of flux. Todays instruments will become tomorrows news, as metallurgical principles
and manufacturing techniques continue to push the
envelope. All of the major dental companies are actively involved in surpassing the boundaries of science and technology. This is especially true in shaping
root-canal systems.
Fig. 1
According to the American Association of Endodontists, 41,000 root canals are performed each day
worldwide. In the US, 15 per cent of people still avoid
any kind of dental treatment. Statistics point to the
need for endodontic treatment. In a busy generalist
practice, most endodontic treatments are referred to
the specialist. Since the middle of 2006 and the
change in world economics, an increasing number of
general dentists have begun performing endodontic
treatment in the office. Academically, most dentists
had limited exposure to endodontics during their student training; therefore, their confidence in performing endodontics in their office is low.
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The goal of this article is to aid the reader in choosing a shaping system that is easy to use and simple in
design with a focus on safety. Leonardo da Vinci once
said, Simplicity is the ultimate sophistication. The TF
Adaptive system (Axis | SybronEndo) epitomises that
concept (Fig. 1).
Fig. 2
Fig. 3
_Clinical impressions
One of the first things I noticed is that the shaping
ability of the file continues the tradition of the Twisted
Files (TF) shaping system (SybronEndo). Reciprocating
motion adds a layer of safety that is unparalleled. Initially, it takes a short time to become used to the interrupted motion of the file. Thereafter, the beauty of
the technique is its simplicity and ease of use. You
place the file into the canal is a single, smooth motion.
Once you feel the engagement, you remove the file
from the canal and wipe it clean, looking for any visible changes in the flute. Then you irrigate the canal
fully and if needed re-enter the canal with the same
Fig. 4
_Conclusion
As a clinical endodontist, I am always looking for
a file system that will offer me a way to shape the rootcanal system easily, predictably and most of all safely.
Over the years, I have come across and used a myriad
of file systems, each one promising to be the latest
and greatest. Some were very aggressive, some were
very stiff, and others tried to be one file fits all. Since
incorporating TF Adaptive into my practice on a daily
basis, and analysing the science behind the technology through a thorough review of the literature, I believe that TF Adaptive and reciprocating motion offers
me the safest, most consistent way to shape a rootcanal system._
_Reference
1. Gambarini et al., Influence of different angles of reciprocation
on the cyclic fatigue of nickel-titanium endodontic instruments,
Journal of Endodontics, 38/10 (2012): 140811.
Fig. 5
_author
roots
Dr Thomas Jovicich
is the director of the West
Valley Endodontic Group
located in Encino, California,
USA. In addition to working
in his private practice,
he has been a key opinion
leader for Sybron Dental
Specialties since 2000.
He lectures around the world
on current concepts and
theories in endodontics.
Dr Jovicich hosts a learning
laboratory in his office for
dentists, teaching them to
perform clinical endodontics on their patients under
the surgical operating
microscope utilising stateof-the-art technology and
materials.
_contact
Dr Thomas Jovicich
Suite 534
5363 Balboa Blvd
Encino CA 91316
USA
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I 23
Adapting to the
anatomy, guided by
the canal
Author_ Dr Philippe Sleiman, Lebanon
_Root-canal anatomy with all of its inherent complexity still represents a very serious challenge to modern root-canal therapy.
Even with many breakthroughs in technology, we are still not capable of fully cleaning
and shaping the root-canal system. It is true
that rotary NiTi files are a very helpful
treatment tool, yet we are still learning
and discovering how to use them effectively to achieve the best possible clinical result with respect to the existing biology and anatomy.
The anatomy often looks seems demanding
because it represents several traps and danger zones
during the shaping and cleaning process. This is true
for the entire length of the canal, but particularly so
in the apical region. Stainless-steel files are still the
first files to be used, in small sizes, usually no more
than #15, in order to avoid failures caused by apical
transportation. Rotary files can shape better and
faster than stainless-steel hand files can, but depending on their design and the alloy used they may
also lead to deformation or straightening of the canal.
For this reason, it is crucial to understand both the design of the instrument and the alloy.
According to multiple studies, ground triangular
cross-section instruments often modify the existing
shape of canals by straightening them in the middle
third. This type of instrument in a mesial canal will often lead to a strip perforation due to the instruments
tendency to lean on the internal portion of the canal
wall. Using this instrument in a reciprocating motion
with fixed angles of rotation has been shown to push
debris forward and out of the root-canal system by
packing the debris internally.
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Fig. 1
Complete System
files in continuous rotation. In these situations, Adaptive Motion may be of great assistance in shaping the
canals safely, respecting the original anatomy. In a
more difficult curve, the angles of rotation are smaller
and change according to the stress applied to the instrument. Clinically, it is very difficult to feel these
changes, but we can determine from the sound that
the file is progressing more slowly or at a lower angle
of engagement. This automatically provides the balanced force required by the instrument to adapt to the
canal in order to provide the optimal shape for cleaning of the root-canal system. This is best described
as interrupted but continuous rotation with variable
reciprocation according to resistance.
_Case 1
Spooked is the right word to describe my feelings
when I first saw this X-ray (Fig. 2). The patient and
I were both concerned about the treatment of this
mandibular molar. It took 18 months for the patient
to return to the office. Fortunately, a mix of doubleantibiotic paste and a small amount of steroid had
been placed in her canals to maintain some stability
during this long period. As the temporary pastes
effectiveness had diminished, the patient was motivated to request an appointment.
Once the patient was in the chair, the other
dentists in my clinic seemed even more excited by
this case than I was because they kept visiting my
operatory. After several seconds of EndoVac usage,
I checked the patency of the canals with a nicely precurved #10 K-file. The distal roots captured my attention because the preoperative X-ray showed very
peculiar anatomy. With very careful scouting of the
canal, I was able to determine that a single opening
led to this very complex root-canal system of multiple canals.
Fig. 2
Starting with the M4 Safety Handpiece (SybronEndo) and a #10 K-file, I established patency and created a path of lower tension for the NiTi files to follow.
I used a sequence of irrigants to prevent the smear
layer from blocking access to the rest of the rootcanal system. Shaping of the canal was a challenge,
and then the moment everyone was waiting for had
arrived.
Adaptive Motion was selected on the Elements
Motor (Axis|SybronEndo), and the golden rule of less
taper behind the curve was on my mind. Since it was
a very unusual case, I chose to approach it in a different way. I first used the #25.08 Twisted File (SybronEndo) for only a few millimetres at the orifice of the
canal to facilitate the access of other files and to
have a stable working length. I then used a #10 K-file
to establish working length. I performed shaping and
Fig. 3
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Fig. 4
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_author
roots
Dr Philippe Sleiman
American Dental Clinic
Dubai
Jumeirah Road
Dubai
UAE
phil2sleiman@hotmail
Registration information:
13 days of live training with the Masters
in Santorini, Geneva, Pesaro + self study
Collaborate
on your cases
University
of the Pacific
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ADA CERP
C.E. CREDITS
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nor does it imply acceptance of credit hours by boards of dentistry.
Eight-year
follow-up of successful
intentional replantation
Authors_ Dr Muhamad Abu-Hussein, Greece; Dr Sarafianou Aspasia, Greece; & Dr Abdulgani Azzaldeen, Israel
Fig. 1
Fig. 1_Pulpal diagnosis: necrosis,
narrow periodontal pocket 10mm
deep, Grade I+ mobility.
_Abstract
Intentional replantation has been practised for
many years as a treatment modality for pulpless
teeth. Although the success ratio for intentional replantation is far below that for routine or surgical
endodontics, this procedure should be considered an
alternative to tooth extraction. A case of mandibular
second molars treated with intentional replantation
and retrograde fillings is reported in this article. At the
eight-year recall visit, radiographs showed no evidence of pathological changes.
_Introduction
Intentional replantation (IR) is the extraction of
a tooth to perform extra-oral root-canal therapy,
curettage of an apical lesion when present and its
replacement in its socket.1,2 Grossman in 19823
28 I roots
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_Case report
Fig. 2
Fig. 3
Fig. 4
Fig. 5
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Fig. 7
_Discussion
Intentional replantation is an accepted endodontic procedure in cases in which intra-canal and surgical endodontic treatments are not recommended.
Although not frequently used, IR is a treatment option that dentists should consider under these conditions. If the standard protocols during IR are not
followed, root resorption and ankylosis may be observed within one month and one to two months,
respectively.17,18 Most resorptive processes are diagnosed within the first two to three years. However,
although rare, new resorptive processes could occur
even after five or ten years.17
As various investigators report varying success
rates, it is difficult to predict the outcome for IR.
Bender and Rossman19 evaluated 31 cases with an
overall success rate of 80.6 % (six recorded failures).
Replanted teeth survived from one day to 22 years.
A second mandibular molar that failed after three
weeks was replanted successfully a second time with
no signs of failure after 46 months of follow-up.
Fig. 9
Fig. 10
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Fig. 8
_Conclusion
For extraction and replantation to be successful,
the following criteria must be met:
_Informed consent must be obtained from the patient.
Fig. 11
Fig. 12
_contact
roots
Dr Muhamad Abu-Hussein
123 Argus St.
10441 Athens
Greece
abuhusseinmuhamad@gmail.com
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Fig. 1a
Fig. 1b
_In addition to intra-oral and panoramic radiographs, various visual techniques are available for
endodontic treatment today. Above all, information
obtained through the dental microscope has become
essential.
_author
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See better, do better is a slogan in modern endodontics. The dental microscope is a wonderful tool for
problem-solving in endodontics, for instance for the
removal of broken instruments and root-filling materials, finding missed canals, perforation repair, diagnosis of tooth fractures, evaluation of marginal integrity
of restorations, precise manipulation in periradicular
surgery and deep dental caries, and confirmation of
root-canal cleanliness. Yoshioka et al. (2002), for example, reported that the rate of detection of root-canal
orifices under a microscope was significantly higher
than the number detected with the naked eye. It was
also found that surgical loupes were relatively ineffective compared with the microscope.
In addition, computed tomography (CT) is becoming increasingly popular among endodontists, particularly in the assessment of difficult cases and for problem-solving in endodontic treatment. Higher use (34.2
per cent) of CBCT was demonstrated by a recent webbased survey of active members of the American As-
Fig. 2
sociation of Endodontists in the US and Canada (Dailey et al. 2010). Owing to its high radiation dosage,
however, careful consideration is needed before taking CT images. Consequently, a project team from the
Japanese Association for Dental Science presented a
report in 2010 on the use of CT in dentistry, and a joint
position statement by the American Association of
Endodontists and American Academy of Oral and
Maxillofacial Radiology was issued in February 2011.
The combined use of the dental microscope and CT for
apicectomy was approved as an advanced dental technology by the Ministry of Health, Labor and Welfare in
Japan in 2007, and seven Japanese dental hospitals
have been using the technology since 1 February 2013.
Optical coherence tomography (OCT) is a highresolution imaging technique that allows micrometre-scale imaging of biological tissues over small
distances. It was introduced in 1991 and uses infrared light waves that are reflected from the internal
microstructure within the biological tissues (Shemesh
et al. 2008). There have been reports on its use for intra-canal imaging, diagnosis of vertical root fracture
(Yoshioka et al. 2013) and perforations. Since OCT is
non-invasive and free of radiation, this technology
may be very useful for endodontic diagnosis and
treatment (Figs. 1a2)._
Interaktive Live-Webinare
und On-Demand-Kurse
Dental Tribune Study Club
Das Online-Portal fr zahnrztliche Forbildung
Der Dental Tribune Study Club ist ein umfassendes internationales Web-Portal fr die zahnrztliche Fortbildung. Dabei werden Online-Seminare als interaktive Live-Vortrge oder Aufzeichnung sowie Mitschnitte
von Vortrgen auf internationalen Kongressen einem weltweiten Fachpublikum unkompliziert zugnglich
gemacht.
www.DTStudyClub.de
_contact
roots
Produits Dentaires SA
Vevey . Switzerland
Produits Dentaires SA
Rue des Bosquets 18
1800 Vevey
Switzerland
info@pdsa.ch
This new endodontic filling material was specially developed to be placed with MAP System
but it could be placed with any other technique as
well. The PD MTA White offers the following advantages:
_Optimized particle size;
_Avoids bacterial migration;
_Excellent marginal sealing capacity;
_Stimulates the formation of a dentine layer (pulp
capping).
RECIPROCalso efficient
in retreatment
_Within a short period, RECIPROC has proven to
be a very successful system worldwide for root-canal
preparation using a single instrument.
In addition, the system is effective in removing
gutta-percha and carrier-based filling during retreatment. Thanks to the design of the instrument and its
good cutting ability, the R25 is able to remove filling
material efficiently and reach working length quickly.
_contact
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VDW GmbH
info@vdw-dental.com
www.vdw-dental.com
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Axis | SybronEndo:
Rotary Meets Endo
Author_ Perry Lowe, USA
_contact
roots
36 I roots
3_ 2013
Over the last year and a half, we have been combining the trusted American brand Axis Dental with
the proven SybronEndo brand, with the aim of providing a global brand that focuses on workflow solutions; this led to the creation of the Axis | SybronEndo
tag line Rotary Meets Endo. The Axis products satisfy
your restorative and endodontic hardware needs with
a wide range of rotary instruments, diamonds, carbides and polishers that complement our SybronEndo
endodontic product portfolio.
What is most exciting about our future
is our increased commitment to driving
innovation that improves your experience with our products and improves quality of life for your patients. Recently, we introduced TF
Adaptive, an innovative and complete NiTi file system that optimises
the unmatched technology, design
and clinical results of our classic
Twisted File (TF) design, while offering
you variable reciprocation according to
IFEA
2016
Cape Town, South Africa
With all these advantages, combined with an appropriate heat treatment to lend progressive flexibility to the files,2 EDM signals a new era in the industrial production of NiTi files and the development of
innovations in endodontology.
Fig. 1
Fig. 2
_Preliminary results
Fig. 1_neoniti C1 (S25 - T12 - L10)
Fig. 2_neoniti A1 (S25 - T8 - L25)
roots
_contact
NEOLIX SAS
11, av. Raoul Vadepied
53600 Chtres-la-Fort
France
neolix@neolix.eu
www.neolix.eu
38 I roots
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www.idem-singapore.com
INTERNATIONAL DENTAL
EXHIBITION AND MEETING
APRIL 4 - 6, 2014
Endorsed By
Supported By
Held In
In Cooperation With
Co-organizer
International
Ms. Stephanie Sim
T: +65 6500 6723
F: +65 6296 2771
E: s.sim@koelnmesse.com.sg
I meetings _ events
International Events
2013
ESE Biennial Congress
1214 September 2013
Lisbon, Portugal
www.e-s-e.eu
Canadian Academy of Endodontics
Annual General Meeting
1622 September 2013
Ottawa, Ontario, Canada
www.caendo.ca
Italian Academy of Endodontics (AIE)
AIE National Congress
35 October 2013
Montecatini Terme, Italy
www.accademiaitalianaendodonzia.it
AMED Annual Meeting & Scientific Session
35 October 2013
Orlando, Florida
www.microscopedentistry.com
40 I roots
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submission guidelines:
Please note that all the textual components of your submission
must be combined into one MS Word document. Please do not
submit multiple files for each of these items:
_the complete article;
_all the image (tables, charts, photographs, etc.) captions;
_the complete list of sources consulted; and
_the author or contact information (biographical sketch, mailing
address, e-mail address, etc.).
Image requirements
Please number images consecutively throughout the article
by using a new number for each image. If it is imperative that
certain images are grouped together, then use lowercase letters
to designate these in a group (for example, 2a, 2b, 2c).
Please place image references in your article wherever they
are appropriate, whether in the middle or at the end of a sentence.
If you do not directly refer to the image, place the reference
at the end of the sentence to which it relates enclosed within
brackets and before the period.
In addition, please note:
Should you require a special layout, please let the word processing
programme you are using help you do this formatting automatically. Similarly, should you need to make a list, or add footnotes
or endnotes, please let the word processing programme do it for
you automatically. There are menus in every programme that will
enable you to do so. The fact is that no matter how carefully done,
errors can creep in when you try to number footnotes yourself.
Questions?
Magda Wojtkiewicz (Managing Editor)
m.wojtkiewicz@oemus-media.de
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_ 2013
I 41
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international magazine of
endodontology
Publisher
Torsten R. Oemus
oemus@oemus-media.de
CEO
Ingolf Dbbecke
doebbecke@oemus-media.de
Published by
Oemus Media AG
Holbeinstrae 29
04229 Leipzig, Germany
Tel.: +49 341 48474-0
Fax: +49 341 48474-290
kontakt@oemus-media.de
www.oemus.com
Printed by
Members of the Board
Jrgen Isbaner
isbaner@oemus-media.de
Lutz V. Hiller
hiller@oemus-media.de
Managing Editor
Magda Wojtkiewicz
m.wojtkiewicz@oemus-media.de
Executive Producer
Gernot Meyer
meyer@oemus-media.de
Designer
Josephine Ritter
j.ritter@oemus-media.de
Copy Editors
Sabrina Raaff
Hans Motschmann
Editorial Board
Fernando Goldberg, Argentina
Markus Haapasalo, Canada
Ken Serota, Canada
Clemens Bargholz, Germany
Michael Baumann, Germany
Benjamin Briseno, Germany
Asgeir Sigurdsson, Iceland
Adam Stabholz, Israel
Heike Steffen, Germany
Gary Cheung, Hong Kong
Unni Endal, Norway
Roman Borczyk, Poland
Bartosz Cerkaski, Poland
Esteban Brau, Spain
Jos Pumarola, Spain
Kishor Gulabivala, United Kingdom
William P. Saunders, United Kingdom
Fred Barnett, USA
L. Stephan Buchanan, USA
Jo Dovgan, USA
Vladimir Gorokhovsky, USA
James Gutmann, USA
Ben Johnson, USA
Kenneth Koch, USA
Sergio Kuttler, USA
John Nusstein, USA
Ove Peters, USA
Jorge Vera, Mexico
Copyright Regulations
_roots international magazine of endodontology is published by Oemus Media AG and will appear in 2013 with one issue every quarter. The magazine
and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmissible and liable
to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, represent
the opinion of the afore-mentioned, and do not have to comply with the views of Oemus Media AG. Responsibility for such articles shall be borne by the author.
Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility shall be assumed
for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty
representation are excluded. General terms and conditions apply, legal venue is Leipzig, Germany.
42 I roots
3_ 2013
Continuing Education
Exhibition
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dental products and services
at a discount
Connections
Mingle with colleagues
from across the world
Registration is open now.
ADA.org/session
Networking
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